Open AccessInhaled corticosteroids and the risks of low‐energy fractures in patients with chronic airway diseases: A propensity score matched study
Author(s) -
Tsai ChunHao,
Liao LinYu,
Lin ChengLi,
Chung WeiSheng
Publication year - 2018
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12744
Subject(s) - medicine , hazard ratio , asthma , copd , proportional hazards model , confidence interval , comorbidity , exacerbation , propensity score matching , osteoporosis , emergency department , cohort , cohort study , psychiatry
Background and Aims Inhaled corticosteroids (ICSs) are crucial anti‐inflammatory medications for chronic airway diseases. Studies investigating the relationship between ICSs and fractures in Asian populations are scant. We investigated whether ICSs increased the risk of low‐energy fractures in patients with chronic airway diseases. Methods We used the Longitudinal Health Insurance Database to select patients aged 20 years and older with chronic airway diseases (asthma and COPD) between 2000 and 2011 as the base cohort. We identified ICS users and ICS non‐users matched by propensity score method at 1:1 ratio. Cox proportional hazard regression models were used to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for factors associated with the risk of fracture. Results A total of 1,182 ICS users and 1,182 controls were enrolled. After adjustment for age, gender, annual exacerbation number of acute respiratory events, comorbidity and medications, the risk of fracture was 1.10 for ICS users (aHR = 1.20; 95% CI = 1.10‐1.31) compared with ICS non‐users. The ICS users exhibited significantly 1.63‐fold risk of hip fracture and 1.24‐fold risk of ulna and radius fracture than did the ICS non‐users. Patients with medium and high doses of ICS use were associated with significantly increased risks of fracture (aHR = 1.48, 95% CI = 1.25‐1.76 for medium dose and aHR = 1.55, 95% CI = 1.39‐1.72 for high dose) compared with those in ICS non‐users. Conclusions Patients with medium and high doses of ICS use are associated with an increased risk of fracture.